OBJECTIVES: According to the World Health Organization (WHO), infertility rates have been steadily rising worldwide. Identifying risk factors for contrast agent reflux into the myometrium during hysterosalpingo-contrast sonography (HyCoSy) is of clinical significance in reducing this complication and improving infertility treatment. However, there is currently no standardized pre-evaluation method for predicting intra-myometrial contrast reflux, with clinical assessment often relying on physician experience and patient symptoms. This study aims to identify imaging risk factors for contrast agent reflux into the myometrium using four-dimensional (4D) HyCoSy and to construct a nomogram-based predictive model to assist in clinical decision-making. METHODS: A retrospective analysis was conducted on 1 274 infertile women who underwent 4D HyCoSy at the Women and Children's Hospital of Hunan and the the Third Xiangya Hospital of Central South University from January 1, 2020, to December 15, 2022. Patients were divided into a reflux group (n=234) and a non-reflux group (n=1 040) based on the presence of intra-myometrial contrast reflux. Univariate and multivariable Logistic regression analyses were used to identify significant predictors, which were then used to construct a nomogram model. Internal validation was performed using 500 bootstrap resamples. RESULTS: The age of the reflux group was significantly higher than that of the non-reflux group [(31.82±5.27) years vs (30.66±4.83) years, P=0.001 1]. Primary infertility was more common in the non-reflux group (50.96%), while secondary infertility dominated in the reflux group (76.50%), with 72.65% having a history of gynecological surgery (P<0.001). Abnormal menstrual volume and discomfort during the procedure were more common in the reflux group, while the non-reflux group tolerated higher contrast agent doses (P<0.001). Imaging differences included endometrial thickness, tubal wall smoothness, and peritoneal contrast dispersion, with the non-reflux group showing thicker endometrium and smoother, more patent tubes. The nomogram model yielded an area under the curve (AUC) of 0.854, indicating good predictive performance. The AUC of the decision curve analysis (DCA) for internal validation of the model was 0.737. When the threshold probability for contrast agent reflux into the myometrium ranged from 0.05 to 0.95, the maximum net benefit reached 0.18. The net benefit of applying the nomogram predictive model exceeded that of either full intervention or no intervention, indicating that the model demonstrates good clinical predictive performance. CONCLUSIONS The nomogram model, based on infertility type, endometrial thickness, contrast agent dose, and discomfort symptoms, effectively predicts intra-myometrial contrast agent reflux after 4D HyCoSy. It provides a valuable tool for clinicians to implement early preventive measures and reduce the risk of contrast leakage and associated complications.
Humans ; Female ; Nomograms ; Contrast Media/adverse effects* ; Retrospective Studies ; Adult ; Ultrasonography/methods* ; Hysterosalpingography/methods* ; Infertility, Female/diagnostic imaging* ; Myometrium/diagnostic imaging* ; Risk Factors

Objective:To explore the relationship between rumination and depression and suicide attempts, and the mediating effect of rumination between depression and suicide attempts in adolescents with depressive disorder.Methods:Clinical interviews and questionnaires were conducted on 331 adolescents aged 11-18 with depressive disorders.Depressive symptoms were assessed with patient health questionnaire-9 (PHQ-9). Rumination was assessed with ruminative responses scale-10 (RRS-10), and Chinese version of the sociality module of MINI5.0 was used to assess suicide.SPSS 23.0 software was applied to descriptive statistics, Chi-square test, t-test, Spearman correlation analysis and hierarchical regression analysis, and the SPSS macro program PROCESS V 3.4 was used for Bootstrap mediating effect. Results:The incidence of suicide attempts in adolescents with depressive disorder was 53.78%, which was significantly higher in girls (59.48%) than that in boys (40.40%), and the difference was significant ( χ2=10.16, P<0.01). In contrast to the non-suicide attempt group, suicide attempt group had higher scores on PHQ-9((11.08±9.26) vs (14.43±7.49), t=-3.634, P<0.01), brooding ((10.76±3.89) vs (12.44±3.87), t=-3.926, P<0.01), reflection ((10.05±3.54) vs (11.20±3.33), t=-3.044, P<0.01) and rumination total score ((20.81±6.78) vs (23.64±6.42), t=-3.898, P<0.01). Regression analysis revealed that girl ( β=0.175, t=3.228, P=0.001), depressive symptoms ( β=0.168, t=3.082, P=0.002), rumination ( β=0.138, t=2.364, P=0.019) were risk factors for suicide attempts.Rumination played a complete mediating effect between depressive symptoms and suicide attempts (effect value=0.013, 95% CI=0.003-0.027). Depression symptoms significantly and positively predicted rumination ( P<0.01), and rumination significantly and positively predicted suicide attempts ( P<0.05). Conclusion:The incidence of suicide attempts was high in adolescents with depressive disorders.Depressive symptoms affect suicide attempts mainly through rumination.Clinicians should assess the rumination of adolescents with depressive disorders.In addition, clinicians should implement concurrent psychotherapy to adjust the cognitive response and reduce rumination, in order to improve the mental health and reduce suicide attempts.

OBJECTIVE: To explore the effect of mindfulness meditation training for improving anxiety, depression and sleep disorders in perimenopausal women. METHODS: Intervention by menopause meditation training was delivered in 121 perimenopausal women with anxiety, depression or sleep disorders in Baiyun District, Guangzhou. Before and after the intervention, the Self-rating Anxiety Scale, Self-rating Depression Scale and Pittsburg Sleep Quality Index were used for assessment of changes in the conditions of the women. RESULTS: After menopausal meditation training, the perimenopausal women showed significant improvement in the mean scores of Self-rating Anxiety Scale (48.26 ± 6.47; =3.865, < 0.01), Selfrating Depression Scale (50.27 ± 6.54; =4.541, < 0.01) and Pittsburgh Sleep Questionnaire (10.64 ± 4.38; =5.596, < 0.01). The symptom remission rates differed significantly among the women with different self-practice frequencies ( < 0.01). The remission rates of anxiety, depression and sleep disorder increased significantly with the frequency of self-exercise ( < 0.01). CONCLUSIONS Mindfulness meditation training can effectively alleviate the symptoms of anxiety and depression and improve the quality of sleep in perimenopausal women, and the frequency of the exercise is positively correlated with the improvements. Mindfulness meditation training can be an effective intervention for improving the mental health of perimenopausal women.
Anxiety ; Depression ; Female ; Humans ; Meditation ; Mindfulness ; Perimenopause ; Sleep

OBJECTIVETo explore the association between hyperbilirubinemia and apnea in premature infants.

METHODSPremature infants with apnea and birth weight >1500 g were tested for the heart rate, serum level of bilirubin, saturation of blood oxygen (SO₂) and partial pressure of oxygen (PO₂) before and after treatment, with term infants serving as the control. A comparative analyses of the serum level of bilirubin, SO₂ and PO₂ were carried out in the premature infants with birth weight <1500 g suffering apneic syndrome or not on the first and third days after birth.

RESULTSOf the premature and term infants with apnea and birth weight <1500 g, 92.5% and 70.00% showed increased serum level of indirect bilirubin (IBIL), respectively. The infants with birth weight <1500 g who presented the syndrome of apnea on the first day after birth had significantly higher levels of IBIL than those without an apparent syndrome of apnea. A three-day conventional therapy resulted in an obvious improvement of apneic syndrome and lowered bilirubin level.

CONCLUSIONIncreased bilirubin level can be one of the reasons for the development of apnea in premature infants, and therapies for reducing bilirubin level can ameliorate the syndrome of apnea.

Apnea ; blood ; complications ; Bilirubin ; blood ; Female ; Humans ; Hyperbilirubinemia ; complications ; Infant, Newborn ; Infant, Premature ; Male